The practice includes the partial or total removal of external genitals, for cultural or other nonmedical reasons, and it can lead to long-term social and health effects, especially related to childbirth. Female genital cutting affects over 200 million women and girls worldwide, primarily in sub-Saharan Africa, according to the World Health Organization. Now, as part of a coalition of organizations, the Drexel Women's Care Center will play a key role in addressing the specific health needs of this population in Philadelphia over the next three years.

The Philadelphia International Women's Project is a partnership between Drexel, Nationalities Service Center and the African Family Health Organization. The project is part of a $6 million grant from the U.S. Department of Health and Human Services that was awarded to eight sites across the country.

"The thought from HHS was that there is a large population of women coming to the United States from countries where female genital cutting is a cultural norm, and there are very obvious gaps in services for women who have experienced it," says Sandra M. Wolf, MD, executive director of the Women's Care Center and an associate professor of obstetrics and gynecology in the College of Medicine. "Immigrant communities are so vital to Philadelphia's economic growth. Recognizing the needs of these women is important to any sector, and health care in particular."

The objectives of the Philadelphia International Women's Project include:

• Building community partnerships to increase community engagement around female genital cutting and reduce stigma
• Utilizing a peer-to-peer model to engage affected communities in outreach and education, while facilitating connections to appropriate supportive services
• Providing essential clinical services to affected women in a culturally sensitive health care home
• Increasing medical provider competency through a comprehensive provider education initiative that focuses on teaching effective and culturally sensitive female genital cutting care strategies

Over her years in practice, Wolf has cared for hundreds of patients who have experienced female genital cutting. "But it was only to a small extent until I began to do more work with attorneys representing women seeking asylum on that basis," she says. Soon after, she integrated care specifically for this population of women and girls into services provided at the Women's Care Center.

Wolf has seen a wide range of patients with diverse feelings about female genital cutting and its consequences.

Some women believe female circumcision is a cultural practice that should continue, and rather than feeling mutilated, they see the cutting as a minor issue in their lives, Wolf says.

Other female patients immigrated to the United States shortly after being circumcised, without ever having discussed the procedure with anyone. Once they learn they look different from their peers here, as teenagers or young adults, it is often a traumatic revelation, Wolf says.

"I think the most important thing a provider can do in that situation is to let a woman know she will be able to live a normal life. She'll be able to have intimacy and a family, and we will help her to talk to her partner," she says.

During the three-year project, the Women's Care Center, Nationalities Service Center and the African Family Health Organization will work to educate both health care providers and community members about female genital cutting, as well as to increase clinical services for women who have been affected by female genital cutting and to work toward prevention strategies.

"We would like the Women's Care Center to be a meaningful place in the community, where we can address any unmet needs in health care related to female genital cutting for women and their partners," Wolf says. "And we want to ensure that all health care settings are prepared for this population, that providers understand the ethical and legal aspects surrounding the issue as well."